Sung Hsin-Pei, Chen Wei-Cheng
Department of Orthopedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan.
Knee Surg Sports Traumatol Arthrosc. 2025 Feb;33(2):695-706. doi: 10.1002/ksa.12365. Epub 2024 Jul 15.
To compare side-to-side superior capsular reconstruction (SCR) with over-the-top SCR in terms of functional outcomes, pain relief and allograft survival rates.
Patients who had undergone arthroscopic dermal allograft SCR for massive irreparable rotator cuff tears and clinical follow-up for ≥2 years were recruited. All patients underwent postoperative assessment with routine radiographic analysis for acromiohumeral distances, ultrasound imaging 1 and 3 months after SCR and magnetic resonance imaging (MRI) at least 12 months after SCR. The outcome measures were visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant and Single Assessment Numeric Evaluation (SANE) scores.
SCR was performed in 56 patients including side-to-side SCR in 32 and over-the-top SCR in 24. Postoperative MRI showed that the grafts were intact in 46 patients (82.1%; 26 who underwent side-to-side SCR and 20 who underwent over-the-top SCR). The proportion of nonhealing grafts in the over-the-top group was significantly higher with concomitant subscapularis tears (60% vs. 5.3%; p = 0.02). VAS scores and functional outcomes improved postoperatively in both groups and postoperative VAS (1.4 vs. 1.7; n.s.), Constant (74.8 vs. 76.0; n.s.), mean ASES (87.4 vs. 89.1; n.s.) and mean SANE (81.7 vs. 84.3; n.s.) scores did not differ significantly.
For massive rotator cuff tears, over-the-top and side-to-side SCR achieve similar pain relief and functional improvement, and the rate of healing allografts is high. However, over-the-top SCR is not recommended for massive posterosuperior rotator cuff tears with repairable subscapularis tendon tears due to a higher nonhealing rate.
Level III.
比较双侧上盂唇重建术（SCR）与经肩峰上入路SCR在功能结局、疼痛缓解及同种异体移植物存活率方面的差异。
招募接受关节镜下真皮同种异体移植物SCR治疗巨大不可修复性肩袖撕裂且临床随访≥2年的患者。所有患者术后均接受常规影像学分析以评估肩峰下间隙，在SCR术后1个月和3个月进行超声检查，并在SCR术后至少12个月进行磁共振成像（MRI）检查。结局指标包括视觉模拟评分（VAS）、美国肩肘外科医师协会（ASES）评分、Constant评分和单项评估数字评定（SANE）评分。
56例患者接受了SCR，其中32例行双侧SCR，24例行经肩峰上入路SCR。术后MRI显示，46例患者（82.1%；26例行双侧SCR，20例行经肩峰上入路SCR）的移植物完整。经肩峰上入路组中合并肩胛下肌撕裂时移植物不愈合的比例显著更高（60%对5.3%；p = 0.02）。两组术后VAS评分和功能结局均有改善，术后VAS评分（1.4对1.7；无统计学差异）、Constant评分（74.8对76.0；无统计学差异）、平均ASES评分（87.4对89.1；无统计学差异）和平均SANE评分（81.7对84.3；无统计学差异）无显著差异。
对于巨大肩袖撕裂，经肩峰上入路和双侧SCR在疼痛缓解和功能改善方面效果相似，同种异体移植物愈合率较高。然而，由于不愈合率较高，对于伴有可修复肩胛下肌腱撕裂的巨大后上肩袖撕裂，不建议行经肩峰上入路SCR。
三级。
